Healthcare Provider Details

I. General information

NPI: 1538862321
Provider Name (Legal Business Name): INCLUSIVE ABA NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PENNSYLVANIA AVE STE 600
ROSWELL NM
88201-4665
US

IV. Provider business mailing address

1525 PROSPECT ST STE 603
LAKEWOOD NJ
08701-4642
US

V. Phone/Fax

Practice location:
  • Phone: 575-210-7377
  • Fax:
Mailing address:
  • Phone: 347-946-5515
  • Fax: 303-616-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JT GUTMAN
Title or Position: OWNER/CEO
Credential:
Phone: 303-616-1188